Periodontal probes

1. PERIODONTAL PROBES GUIDED BY: DR. RUPINDER KAUR PRESENTED BY: DR. MALVIKA THAKUR I YEAR

2. CONTENTS Introduction Uses of periodontal probes History of periodontal probes NIDCR Criteria Classification of periodontal probes Related Studies Non periodontal probes Basic concepts of probing technique Conclusion References

3. INTRODUCTION Probe – “to test” A calibrated probe used to measure the depth and determine the configuration of a periodontal pocket. (Glossary of Periodontal Terms 2001- 4 th edition) 1882 – John M Riggs – described probe . 1915 -1958 , several studies - supported use of the periodontal probe - to determine the disease status of gingival tissues . Periodontal probe and its use was first described by F.V. Simoton of the University Of California, San Francisco in 1925. Orban (1958) described the periodontal probe as “the eye of the operator beneath the gingival margin.” 1/

4. Goldman et al . stated that “Clinical probing with suitable periodontal instruments such as the Williams calibrated probe is a prime necessity in delineating the depth, topography and character of the periodontal Pocket” Glickman stated that “The probe is an instrument with a tapered rod-like blade which has a blunt and rounded tip” Rationale behind periodontal probing Detect and measure loss or gain of attachment level TO Determine the extent of previous or ongoing disesase activity AND Assess the effect of ongoing treatment. 4

5. 5 Assess the periodontal status for preparation of treatment plan. Measure - pocket depths & clinical attachment level Determine relationship of the gingival margin, attachment level, and the mucogingival junction . Locate calculus M easure the width of attached gingiva. Evaluate gingival bleeding on probing. Locate and measure furcation involvements Measure the extent of apparent, visible gingival recession. Determine the consistency of the gingival tissue . Evaluate tissue response to professional treatment post operatively. USES OF PERIODONTAL PROBES

6. HISTORY F irst described as a periodontal diagnostic instrument by John M Riggs in 1882. The III edition of G.V. Black’s Special Dental Pathology published in 1924 mentions “the use of very thin flat explorers to determine the depth of pockets”. Periodontal probe and its use was first described by F.V. Simoton of the University Of California, San Francisco in 1925 . The first classification of periodontal probes was given by B. L Philstrom in 1992 (I – III Generations of probes) In 2000 Watts added IV & V Generations. 6

7. Simonton (1925) proposed flat probes 1mm wide, 10mm long and notched every 2mm. Box (1928) used special gold or silver probes that had 5 different angulations. Miller (1936) suggested probing of all pockets and recording their depth and putting this information on the diagnostic chart. He used a medium thickness silver abscess probe or scalers, with a blunt blade. The probes most commonly used today were developed by Ramfjord in 1959 . In the late 1950’s, Goldman et al, Orban et al, and Glickman published their texts on periodontal disease - agreed on the importance of the periodontal probe in diagnosis, prognosis and treatment, and supported use of the Williams probe. 7

8. 2. Color Coding . Color-coded probes are marked in bands (often black in color ) with each band being several mm in width. Characteristics of probe 8 1. Millimeter Markings The working-end of the probe is marked at mm intervals . grooves , colored indentations, or colored bands may be used to indicate the mm markings on the working-end. Each mm may be indicated on the probe or only certain mm increments may be marked UNC 15 Probe 1­,2,­3,­4,­5,6,­7­,8,­9­,10,­ 11,­12­,13­,14,­15 Color coded at 5,10&15 Marquis color coded probe 3,­6,­9,­12 Color coded : 3 to 6 & 9 to 12 mm

9. 1. Curved working end - non-calibrated furcation probe - narrow, smooth probe with round blunt end. 2. Straight working end a. Shape – slender, rod like, with a smooth rounded end; may be I . In design Tapered Straight Flat ii.In cross section Round -> Michigan, Gillmore , Merritt , Williams & Marquis Rectangular -> Goldman Fox, Drellich & Nabers 9

10. PROBE DIAMETER There are numerous reports using various tip diameters (0.4, 0.5, 0.6, 0.8 and 1.0 mm). Van der Velden and Jansen (1981) suggested that with a probe 0.63mm in diameter, the optimal force to probe the most coronal connective tissue attachment was 0.75 N. Keagle and Garnick (1989) - Probe diameter of 0.6 mm discriminated best, the different levels of gingival inflammation and health. It is recommended that, to measure the new sulcus depth, but not to penetrate the long junctional epithelium, forces of 20 grams should be used with a probe tip diameter 0.6 mm. 10

11. NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH (NIDCR) CRITERIA FOR OVERCOMING CONVENTIONAL PROBING 11

12. Periodontal probes are classified as: 1 st generation probe 2 nd generation probe Pihlstrom 3 rd generation probe 4 th generation probe Watts 5 th generation probe Classification 12

13. Conventional or manual probes, made up of stainless steel or plastic. No pressure or force measuring device attached. Working end – round , tapered, flat or rectangular with smooth rounded end. Caliberations – mm First generation probes 13

14. John M Riggs (1882 ) G.V Black (1887) – Probe tips – flat blades : 1.5mm wide & 8mm long – slightly bent R/L. - Also used – endodontic files – difficult acess . HK Box (1928) – WG Cross (1966) - Set of 6 Periodontal probes – “Treatment of periodontal pocket” - 3 probe types – soft sterling silver – diff in size &form of blades. - Markings 1-16mm on one side , 2,4,6 mm – emphasized. 14

15. Sachs (1929)- introduced periodontal probes for the first time in Europe “ Paradentometer ” - Thin , 1.3mm wide V2A steel blade ( bendable) - 6 grooves at 2mm distance Struckmann (1934)- a set of 6 probes ( stainless steel) probe tips were 3 – 8 mm long 15

16. CHM Williams (1936) – most popular probe 13 mm stainless steel tip Prototype for the development of Merritt probes & University of Michigan O probe EW Fish (1946)– probe tip – rounded & tapered - 10mm long & perpendicular to handle Muhlemann (1960) – ZIS probe 13mm & 115ᵒ angle Williams probe 16

17. UNC 15- color coded probe Marquis 1965- color coded probe. Calibrations are in 3mm sections. Markings are 3,6,9,12 mm 17

18. WHO (1978)– CPITN probe Prof. George S Beagre and Jukka Ainamo Tip length- 16mm Angle -90ᵒ. Schmid (1967)– Plast - O - Probe Flexible blade shaped tip 0.2 mm thick & 1.5 mm wide 18

19. CPITN-E Probe ( Epidemological Probe) Markings at 3.5 and 5.5mm. CPITN-C Probe(Clinical Probe) Markings at 3.5, 5.5, 8.5 and 11.5mm. Ball Tip - 0.5 mm 19

20. Modifications of William’s Probe Goldman Fox Probe Calibrations same as Williams probe`s flattened not round University Of Michigan O Probe Without Williams Marking Markings are at 3, 6, and 8mm 20

21. Glickman Periodontal Probe It has rounded tip with longer shank. 1-2-3-5-7-8-9-10 mm markings. Naber’s Probe 21

22. Plastic Probes For Implants Several different companies are manufacturing plastic instruments and gold –coated curettes for use on titanium and other implant abutment metals. It is important that plastic rather than metal instruments be used to avoid scarring and permanent damage to the implants. 22

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24. Muhleman & Son (1971) – bleeding on gentle probing Waerhaug (1952) – light hand pressure – ≤ 0.2N/mm² Gabathuler & Hassel (1971) – 1 st pressure sensitive probe. - with the objective- quantitiating “gentle probing” - constisted of standard ZIS probe & piezoelectric pressure sensor Hunter (1990)– TPS probe 24

25. An electronic pressure sensitive probe– Polson et al (1980) Pen like handpiece & a control base 0.25 N (2.6 N/mm²) Audio signal Yeaple probe 25

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27. These are computerized probes . The probing errors can be avoided by use of computers Jeffcoat et al (1986)– Foster Miller Probe Third generation probes 27

28. D evised by Gibbs et al in 1988 . C onsists of a probe, handpiece and sleeve; a displacement transducer; a foot switch; and a computer interface/personal computer. The hemispheric probe tip has a diameter of 0.45 mm, and the sleeve has a diameter of 0.97 mm. Constant probing pressure of 15 gm is provided by coil springs inside the handpiece . FLORIDA PROBE 28

29. Florida probe with stent Ledge on acrylic stent is used as reference point Florida probe without stent Occlusal surface or incisal edge is used as reference point 29

30. McCullock & Birek (1991) – Toronto Automated Probe Used occluso incisal surface Probing with 0.5 mm NiTi wire Advantage- incorporated electronic guidance system Disadvantage- same head position required Bose & Ott (1992) – Inter Probe ( PerioProbe ) Stainless steel probe- cause pain Tip – 0.5mm, probing force- 15 gm 30

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32. Fourth generation Watts (2000) - 3D probes These are three dimensional probes in which sequential probe positions are measured. 32

33. Eliminates the disadvantages of earlier generation probes The only 5 th generation probe- Ultra Sonographic (US) probe Hinders & Companion (1999) Fifth Generation 33

34. Component of the probe - contra-angled handpiece , computer, electron box for water control, foot pedal, transducer emits and receives sound waves. 34

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36. RELATED STUDIES Rams TE , Slots J (1993) 3  periodontal probes - manual probe and two computerized, pressure-sensitive probes. robing depths were determined . Results - an electronic, pressure-sensitive probe yields more reproducible probing depth measurements than a conventional manual periodontal probe 36

37. L. Mayfield * ,  G. Bratthall,  R. AttStröm(2005) Aim - To compare the relative intra- and inter-examiner reproducibility of 4 different periodontal probes. 1 . The Hu- Friedy LL 20 Probe, a manual probe. 2 . The Vivacare TPS Probe, a plastic manual probe with a standardised pressure of 0.20 N 3 . The Vine Valley Probe, an electronic probe using a standardised pressure of 0.25 N 4 . The Peri Probe Comp, a computerised electronic probe with a controlled pressure of 0.45 N Results show that the manual probe had the lowest degree of variation, with a correlation coefficient of 0.83. The manual and Peri Probe Comp frequently recorded deeper probing pocket depths compared to the TPS and Vine Valley probes. 37

38. Garnick JJ ,Silverstein L J Periodontol.2000 Aim -To determine the importance of the diameter of periodontal probing tips in diagnosing and evaluating periodontal disease. RESULTS: T he pressure used to place the probe tip at the base of the periodontal sulcus/pocket was approximately 50 N/cm2 and at the base of the junctional epithelium, 200 N/cm2. A tip diameter of 0.6 mm was needed to reach the base of the pocket. Clinical inflammation did not necessarily reflect the severity of histological inflammation. Probe tips need to have a diameter of 0.6 mm and a 0.20 gram force (50 N/cm2) to obtain a pressure which demonstrates approximate probing depth. 38

39. NON PERIODONTAL PROBES Calculus Detection Probes Detect Tar Probe ( Dentsply ) Audio readings Disadvantages Perioscope - 39

40. 3. Keylaser -- InGaAs ; Er:YAG laser Periodontal Disease Evaluation System Detects periodontal disease at an early stage 40

41. Periotemp Probe ( Abiodent ) Temperature sensitive probe Detects early inflammatory changes in gingival tissues Two LEDs Red emitting diode Green emitting diode 41

42. Basic concepts of probing ADAPTATION The side of the probe tip should be kept in contact with the tooth surface. The probe tip is defined as 1 to 2 mm of the side of the probe . Correct In correct 42

43. PARALLELISM The probe is positioned as parallel as possible to the tooth surface. The probe must be parallel in the mesiodistal dimension and faciolingual dimension. Probe Parallel to Long Axis. Probe is correctly positioned parallel to the long axis of the tooth . Probe Not Parallel to Long Axis. Probe is incorrectly positioned in relation to the long axis of the tooth . 43

44. INTERPROXIMAL TECHNIQUE When two adjacent teeth are in contact, a special technique is used to probe the area directly beneath the contact area 44

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46. PROBING DEPTH MEASUREMENTS Six sites per tooth One reading per site Full millimeter measurements 46

47. POSITIONING AND SEQUENCE FOR PROBING 47

48. Probing is the act of walking the tip of a probe along the junctional epithelium within the sulcus . THE WALKING STROKE 48

49. MEASUREMENT OF CAL,RAL 49

50. TRANSGINGIVAL PROBING 1.Gingival Recession 2.Histological Probing 3.Clinical Probing 4.Bone sounding 50

51. PROBING HEALTHY VERSUS DISEASED TISSUE . Position of Probe in a Healthy Sulcus . In health, the probe tip touches the junctional epithelium located above the cemento-enamel junction. Position of Probe in a Periodontal Pocket. In a periodontal pocket, the probe tip touches the(JE) located on the root below the cemento -enamel junction.. 51

52. PERI IMPLANT PROBING The results obtained with peri implant probing cannot be interpreted same as the natural teeth because: - Differences in the surrounding tissues that support implanted teeth. - Probe inserts and penetrates differently. The probing depth around implants presumed to be “healthy” has been about 3mm around all surfaces. 52

53. CONCLUSION Newer developments in the field of periodontal probes provide the potential for error-free determination of pocket depth. With more research and innovation, the advent of newer error-free probes may resolve the remaining problems and those yet to be realized. 53

54. Hefti F. Clinical Reviews in Oral Biology & Medicine 1997;8(3):336-356. Ramachandra S. Periodontal Probing Systems: A Review of Available Equipment. Compendium 2011;32(2):2-11. Newman, Takei, Klokkevold , Carranza. Clinical Periodontology. Tenth Edition. Gehrig J. Fundamentals of Periodontal Instrumentation. Listgarten MA, Mao R, Robinson PJ. Periodontal probing and the relationship of the probe tip to periodontal tissues. J Periodontol . 1976;47(9):511-513 Glossary Of Periodontal Terms. 2001 4 th Edition References 54

55. Box HK. Treatment of the Periodontal Pocket. Toronto: The University of Toronto Press; 1928:83 Simonton FV. Examination of the mouth-with special reference to pyorrhea . J Am Dent Assoc 1925;72:287 -295. Miller SC. Oral Diagnosis and Treatment Planning. PhiladelphiaP : . Blakiston'sS on t' Co.; 1936:239. Orban B, Wentz FM, Everett FG, Crant DA. Periodontics, A Concept- Theorg and Practice. St. Louis: C.V. Mosby Co.; 1958:103. Goldman HM, Schluger S, Fox L. PeriodontalTherapg . St. Louis: C.V. Mosby Co.; 1956:27. Glickman l. Clinical PeriodontologgP . hiladelphia:W B. Saunders Co.; 1958:548 . 55

56. THANK YOU 56